The operation you are having is called a radical vulvectomy. This means the vulva and the lymph nodes in your groin will be removed.
Prior to admission
Your Admission to hospital
You are required to check in at the Admissions desk in the main foyer of the hospital on arrival. You will then be admitted to the Ward.
Please bring to hospital with you any medications you might be taking, your x-rays, as well as nightwear, toiletries and personal belongings. On arrival in the unit the ward clerk and nursing staff will welcome you and orientate you to the ward. Once you have been shown around, the nurse will attend to your admission. This involves asking you a series of questions, as well as taking your blood pressure, temperature, pulse and weight.
The anaesthetist will also see you to discuss your anaesthetic and post operative pain management.
To help reduce the risk of clots in your legs you will be given support stockings to wear. You will also be given Clexane injections and wear calf compression devices (SCCDs) to assist with this. An enema will be given the night before and the morning of your operation to help empty your bowels.
On the morning of your surgery you should have a shower and put on a theatre gown. You may be given premedication, in the form of a tablet or injection, to help you relax.
A nurse from the unit will escort you to theatre, where you will be checked in and taken to the anaesthetic bay. An intravenous drip will be inserted by the anaesthetist. You will then be taken into the operating theatre where a shave of your vulval area will be attended. You will then be anaesthetised.
Your surgery will take approximately 2 hours. You will then be taken to the recovery room where you will wake up, before returning to the ward. Depending on your blood pressure and pain relief you may be in recovery for up to 2 hours.
After the Operation
On return to the ward the nurses will monitor you closely. You will have an intravenous drip in your arm and possibly an infusion for pain relief.
A catheter will be in place, draining urine from your bladder.
You will also have a drainage tube coming from each groin, to drain away the excess fluid.
You will be allowed to eat the day after your operation.
You will be assisted to mobilise a day after your operation by the nurses and physiotherapist.
You will also be shown how to do breathing and leg exercises.
Salt baths will be given 2 times a day to assist in the healing of your wounds.
Your Discharge from hospital
The usual length of stay for this surgery is 4-7 days.
Prior to your discharge you will be given information about what to do during your recovery.
An appointment will be made for you to see your doctor in 2-6 weeks.
At your appointment the doctor will explain the results of your surgery again and any further treatment you may require.
We will continue to see you for follow up at regular intervals.
Possible Complications of Surgery
The operation may involve removing tissue from the walls of major veins and arteries. The average blood loss is 200ml and rarely of patients will require a blood transfusion.
A minor infection of the wound or the bladder occurs in up to 20% of patients. Severe infections are rare.
Remove of the lymph nodes from the groin interferes with the channels draining fluid out of the legs hence leg swelling is quite common. Mostly this swelling is relatively minor but 10-20% of women require intervention in the form of physiotherapy or compression garments.
This is a fluid collection in the groin which develops in about 10-20% of patients. They may not require any treatment but may require draining if large or cause discomfort. Drainage may need to be repeated on several occasions.
Blood clots may develop in the veins of the legs or pelvis. A clot can rarely travel to the lungs causing breathing difficulties and in extreme cases even death. A number of precautions including support stockings, anticoagulant injections, calf compression, leg exercises and early mobilization are taken to decrease the risk of clot formation.
There is approximately 1 in 100000 chance of dying from anaesthesia. However a number of minor complications can occur (e.g. broken tooth, sore throat). Discuss any concerns with the anaesthetist before the operation.
Any surgery causes a degree of discomfort. Post operative pain relief is a priority for our patients and options for analgesia will be discussed with you.
The above list covers the main possible side effects and complications of your surgery but is by no means complete. Please discuss any specific concerns you may have about the proposed procedure.
The list of complications appears daunting but the overall risk of major complication is low.
Results of Treatment
Your surgery can have a number of outcomes:
The cancer has been completely removed and no further treatment is required. Your chance of the cancer returning is less than 10%.
The cancer could not be completely removed and/or it is present in tissues outside the vulva. You will be offered further treatment, usually in the form of radiation therapy possibly with concurrent chemotherapy. In this case complete cure is possible but less likely.